How new imaging techniques can aid in defining the cardiovascular profile of the high-risk patient.

Cardiovascular prevention has been developed in the last eight years producing an ever increasing amount of data requiring frequent updating. Studies using angiography to determine change in coronary obstruction have indicated progression, stabilization, or regression of coronary lesions associated with changes in plasma lipids and lipoproteins. Moreover, the guidelines on arterial hypertension published in 2007 listed the risk factors affecting prognosis but even by 2009 an update modified not only the list of risks, but even the philosophy behind the thought process which introduced as essential element in the prognosis of hypertension the ascertained existence of a damaged organ. Thus, the documentation of atherosclerotic vascular disease (plaques) and the quantification of its extension in the arterial tree became a determinant in the definition of cardiovascular risk. Magnetic Resonance (MRI) and coronary computed tomography (coro CT) applied to the heart and large vessels are the most promising methods.

Dementia and occupational therapy.

In order to evaluate the efficacy of the occupational therapy in patients with dementia, we included in the occupational therapy (OT) program 34 patients with dementia and a moderate to severe cognitive impairment admitted at our RSA. Fourteen of them had vascular dementia (VD), twenty had Alzheimer dementia (AD). For a period of 40 days they followed a daily therapeutic program of OT for washing, personal hygiene (combing their hair, shaving), dressing, sanitary services and eating. Patients were tested with the Ronchi brief evaluation battery (RBEB) before and after therapy. After the treatment we observed a significant improvement in both groups in their mean scores obtained with the RBEB in many of their functional areas. These improvements in patients with vascular dementia were more consistent compared to those patients with AD, but in spite of these differences we saw that, independently from the etiology, it is possible to recuperate residual functional capacities utilizing OT programs in order to guarantee the highest level of autonomy possible for each patient.

Occupational therapy and dementia: the experience of an Alzheimer special care unit.

This trial reports the outcomes of an occupational therapy (OT) program in a group of patients with moderately severe dementia, attending a day care center. Twenty-six patients were enrolled in this therapeutic program for a 12-month period. OT sessions were held for two hour a day, five days a week. The outcomes of the trial suggest that the introduction of OT and multidimensional assessment may improve management and mediate the psychophysical decline of persons with dementia. Indeed, the assessed performance indices remained relatively stable over time, as compared to the decline expected by the natural progression of disease. Moreover, behavioral disorders evaluated by the neuropsychiatric inventory (NPI) scores improved appreciably between treatment start and end. The day care center provides an opportunity for both the person with dementia and their family by optimizing therapy for the patient and providing medical assistance for morbid conditions that ensue during the course of disease and by lowering the burden of care and providing moral support for the family by a trained staff, with particular focus on behavioral disorders that are not amenable to pharmacological management.

The results for the psychomotor rehabilitation programs during stay in the subacute care nursing home.

The modifications of certain psychophysical parameters were evaluated in an elderly population admitted to our subacute care nursing home (abbreviated from the Italian name: "Residenza Sanitaria Assistenziale" as RSA) during the year 2002. These patients, admitted to undergo psychomotor rehabilitative interventions, were evaluated under a cognitive, affective and functional profile at the beginning and at the end of the treatment. Our study showed an increase in all of these performances by the end of the prescribed therapeutic program.

Evaluation of the nutritional status during stay in the subacute care nursing home.

Malnutrition represents an underestimated danger in the elderly population. It is found frequently and casually during admissions to our subacute care nursing homes (abbreviated from the Italian name: "Residenza Socio-Assistenziale" = RSA) when patients are treated for other types of disorders. During a period of 24 months, in our RSA, we found that 93% of patients were malnourished or at risk of malnourishment at admission. Specific interventions allowed us to substantially improve the nutritional status of these patients.

Occupational therapy and tools for monitoring the effectiveness of therapy.

We have constructed a battery of tests for assessment of some aspects of self-sufficiency (washing, dressing, eating) and called it the Ronchi brief evaluation battery (RBEB). The tests were designed to allow for more accurate monitoring of the effects of occupational therapy interventions with patients recovering in our subacute care nursing home (abbreviated from the Italian name: "Residenza Sanitaria Assistenziale" as RSA). The RBEB results showed great advantage, in maximizing levels of independence of patients, of occupational therapy input. Furthermore, when RBEB results are compared to those from the Barthel index, greater improvements are seen in each of the functions tested suggesting that the RBEB results are more detailed and therefore more appropriate. The RBEB tests are based on analysis of the activities of daily living (ADL) and have provided us with brief, clear, accurate, low-cost and practical baseline assessment and review tool.

Is it possible to reduce job burnout of the health care staff working with demented patients?

The Maslach burnout inventory (MBI) was administered to the health care staff of a nursing home before implementing a therapeutic program of occupational therapy and cognitive rehabilitation for demented patients and one year later, while the patients continued the rehabilitative and occupational therapy. All the indices of the MBI showed a significant improvement at the staff's evaluation, when was appraised 12 months after the beginning of the therapeutic program. These treatments seem to have positive effects on both the patients, improving their performances, and the nursing staff, as an aid to reduce the job burnout.

Prospective population survey: do centenarians change?

Two groups of centenarians (32 subjects) were evaluated, residing in the same geographic area, in two sampling periods (1988 and 1992). The characteristics of the groups were compared to see how this age class changed over a 4 year period. Significant differences were found for the number of centenarians, their level of dependency and the use of drugs.

A survey of a centenarian population in Italy, focusing on self-sufficiency and cognition.

Eighty-six persons aged 100 years or older (20 males and 66 females) living in urban areas of different Italian regions were examined between 1985 and 1992, aimed at describing the characteristics of centenarians in an entire population. The female/male ratio was 4 to 1, and 69% of the centenarians lived at home. Body mass index was 21.3 in females and 24.5 in males. The subjects typically reported no major diseases, only a few hospital admittances (1.2/lifetime) and a limited use of regular medication (on average: 1.4 drugs). The mothers and fathers of the centenarians lived 76.2 and 74.2 years, respectively. The Activities of Daily Living scale revealed a decrease in instrumental activities, and an adequate self-maintenance in the majority of centenarians; a full score on the Physical Self Maintenance Scale was reached by 10% of the subjects; these scores were not significantly influenced by the isolated sensory deficits but were lower in patients with multiple impairments. The Mini Mental State Examination score was overall 17.7 +/- 8.3 for the group, reaching 24.1 in male and 20.2 in female literate subjects without major hearing or vision defects; these scores varied significantly in relation to sensory deficits and education. In our centenarian population males reached extreme old age less frequently, but with a better quality of life, than females. The good overall performance of the whole population, and especially of the subpopulation without impairments, suggests a selective survival of centenarians, as also demonstrated by the long lifespan of their immediate relatives.

Hormone levels in centenarians.

The serum profiles of total triiodothyronine (T(3)), free thyroxin (fT(4)), thyroid stimulating hormone (TSH), cortisol, prolactin (HPRL), parathormone (PTH), osteocalcin and growth hormone (GH) were measured in a group of 12 centenarians and compared to the values of a control group of twenty-nine subjects, aged 67-98 years. The study was aimed at revealing whether there are appreciable differences or age-related modifications in the hormone status of healthy control elderly and the centenarian population. In this series, the modifications in hormone levels were unremarkable, and the serum levels of the studied hormones in centenarians often fell within a range considered to be normal for the younger age classes.

Effects of reality orientation therapy on elderly patients in the community.

Twenty-three institutionalized subjects, confused and disoriented as to time, space and persons, were divided into two groups: the study group and the control group. The study group then participated in a 3-month period of formal Realithy Orientation Therapy (ROT). At the end of the 3 months of therapy significant differences emerged in the scores of MMSE, OSGP and GDS obtained by the two groups. Moreover, significant positive differences were observed only in the study group, comparing the tests' results before and after therapy. Even the comparison of the results obtained at the end of the sessions and 3 months after the interruption of the therapy revealed a difference in the trends that emerged for the two groups.

[Spinal anesthesia in the surgery of inguinocrural hernias]. / L'anestesia spinale nella chirurgia delle ernie inguino-crurali.

The experience in the surgical treatment of inguinal and crural hernias with epidural and subarachnoidal anaesthesia over a period of fifteen years (1976-1989) is reported. Results obtained in 1,283 cases confirm the validity of the technique and the clinical course suggests that it could well be applied to cardiopathic, hypertensive, obese, bronchopneumopathic patients as well as to dysmetabolic diseases. Furthermore, advantages of spinal anaesthesia compared to general and local anaesthesia are emphasized. The use of ultrathin needles (24 gauge) in performing subarachnoidal anaesthesia is recommended to prevent headache.